Current Endovascular Treatments in Neuro-Ophthalmology

Endovascular interventions have dramatically contemporized neuro-ophthalmological care in the twenty-first century. This review summarizes interventions with their advantages and disadvantages for intracranial aneurysms, carotid cavernous fistulas (CCF), and idiopathic intracranial hypertension (IIH), all of which are encountered in routine neuro-ophthalmologic practice.

There is a paucity of randomized, controlled trials comparing therapies for intracranial aneurysms, CCFs and IIH, specifically for neuro-ophthalmic outcomes. Flow diversion is a favorable treatment for intracranial aneurysms compressing the optic nerve and other cranial nerves. Coil embolization remains the most common treatment for cavernous carotid fistulas with low rates of secondary cranial neuropathy. Flow diversion has recently been explored in both direct and Type B indirect carotid cavernous fistulas. Lastly, for IIH, venous sinus stenting has become a popular alternative to surgical shunting, though, as with shunts, there is a risk of stent-related complications.

Endovascular therapy has evolved for each vascular disease and continues to transform to meet the needs of its patients. There are advantages and disadvantages to each type of treatment – endovascular or surgical – and the decision is patient-, surgeon-, and institution-dependent.